Treat the Cause
Venous disease may progress to ulcer formation. Ulcers are often serpiginous and seen around the ankle orlower calf region (gaiter area). Lipodermatosclerosis often precedes the development of venous ulcers but is not always present. Venous leg ulcers are the most common cause of all leg ulcers andincrease in frequency with advancing age of the patient.1 The typical venous leg ulcer occurs around the medial aspect of the ankle or lower leg and is often shallow with irregular borders presenting on abackground of skin changes related to chronic venous stasis.
Historically, venous ulcers have been considered to be relatively pain free. However, it is now known that a significant number ofpatients with venous ulcers will experience pain that has an impact on their quality of life (see Table 1).2-8 This pain may be constant or intermittent with procedures or dressing change. Evaluation of thelocation, frequency, and other factors associated with the pain are essential in the assessment and management of patients with venous disease. The clinician should keep in mind that patients mayexperience pain in the absence of an ulcer and may continue to have prolonged pain once an ulcer has healed.
Venous disease is a spectrum of changes that slowly evolve over time with a variety ofassociated pain symptoms ranging from discomfort and aching to deep, chronic pain. Acute, disabling pain may develop with each stage and will impact the plan of care for the patient (see Figure 1).
Themanagement of pain is dependant on the diagnosis of the pain source (see Table 2). Clinically, dependent edema and a dilated saphenous vein are the early signs of venous disease. Patients with pittingedema and prominent varicose veins often will describe a dull aching or heaviness in their legs that progresses toward the end of the day or after prolonged periods of standing. Support stockings,...